Case Report SystemicLupusErythematosusPresentingwithIschemicProctitis and Abdominal Compartment Syndrome Yousaf Bashir Hadi , 1 John Lindsay IV, 2 Syeda Fatima Zehra Naqvi, 1 and Hatim Al-Jaroushi 3 1 Department of Medicine, West Virginia University, Morgantown, WV, USA 2 West Virginia University School of Medicine, Morgantown, WV, USA 3 Department of Medicine, Section of Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, WV, USA Correspondence should be addressed to Yousaf Bashir Hadi; yousaf.hadi@hsc.wvu.edu Received 20 July 2019; Accepted 13 January 2020; Published 13 February 2020 Academic Editor: Olga I. Giouleme Copyright © 2020 Yousaf Bashir Hadi et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ischemic colitis and proctitis is a rare manifestation of systemic lupus erythematosus (LE) and results from mesenteric vasculitis. Owing to diverse blood supply and presence of multiple collaterals, rectum is the least effected site in LE enteritis. Ischemic proctocolitis as the presenting feature of LE is exceedingly rare, with only three cases reported in the published scientific literature. We present the first case of LE presenting as ischemic proctitis, leading to intraperitoneal hemorrhage and abdominal compartment syndrome. A young lady presented with ischemic proctitis and a hematoma masquerading as a pelvic mass, with subsequent development of massive intraperitoneal hemorrhage, shock, and rectal perforation. e patient required urgent surgery and was initiated on high-dose steroids. 1. Introduction Ischemic colitis and proctitis is a rare manifestation of systemic lupus erythematosus (LE). It results from small- vessel vasculitis and is accompanied by high LE disease activity, and can affect the small or large intestine. Diag- nosis is confirmed with sigmoidoscopy and histopathology. Ischemic proctocolitis as the presenting feature of LE is exceedingly rare, with only three cases reported in the published scientific literature [1–3]. No prior reports of hemorrhagic shock and perforations in this setting exist in the current literature. We present the first reported case of ischemic proctocolitis leading to massive intraperitoneal hemorrhage and hemorrhagic shock, with subsequent perforation as the initial presentation of LE. 2. Case Presentation A 39-year-old female presented to West Virginia University Hospitals’ Intensive care unit as a transfer from an outside facility. he had initially presented to the outside facility with abdominal pain of 2 weeks’ duration. e patient experi- enced worsening abdominal pain and weakness on the day of presentation, which prompted her to report to the outside facility. he was found to have a skin rash, involving her arms and face, which was biopsied, revealing a leukocyto- clastic vasculitis. he was also found to have severe anemia and ascites. A computed tomography (CT) scan without contrast was concerning for an irregularity in the rectal lumen with a perirectal pelvic mass or hematoma. Over the course of her stay there, she developed hypotension and shock; she was intubated and transferred to our facility for further evaluation and management. On presentation to West Virginia University, she was found to be in shock. he endorsed a past history of thrombocytopenia; the patient had been told that she had idiopathic thrombocytopenic purpura and splenectomy. he reported lower abdominal pain. Her initial blood pressure was 82/50, and she was pale on examination with large, tense ascites. Her hemoglobin on arrival was 4.4 gram/dl, white Hindawi Case Reports in Gastrointestinal Medicine Volume 2020, Article ID 5723403, 5 pages https://doi.org/10.1155/2020/5723403